Comparison of Drug Related Problems Associated with Use of Narrow Therapeutic Index Drugs and Other Drugs in Hospitalized Patients

Iyer, Kapil; Dilipkumar, Neha; Vasaya, Sharmin; Pawar, Sanjay; Diwan, Arundhati

doi:10.5530/jyp.2018.10.70

Cited by 6 publications

(13 citation statements)

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“…Some studies argued that relationships between duration of treatment, incidences of DRP and length of treatment were one of the risk factors for DRP. 17,[23][24][25] The longer a patient was treated, the more drugs were prescribed, and the risks of DRP would increase. 17,24 Therefore, it is necessary to optimize roles of clinical pharmacists to prevent incidences of DRP.…”

Section: Discussionmentioning

confidence: 99%

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Correlation between geriatric ischemic stroke patient characeteristic and drug related problems

Nugraha

Setiadi

Wibowo

2020

JKKI

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Background: Drug related problems (DRP) can cause problems in treatments of patients with ischemic stroke. Objective: This study was to determine the correlation between the characteristics of patients with ischemic stroke and the DRP. Methods: A population in this study was 53 patients at dr Iskak Public Hospital in Tulungagung. Inclusion criteria were patients who were ≥ 60 years old and were diagnosed as acute ischemic stroke patients. The DRP was classified based on Pharmaceutical Care Network Europe version 6.2, especially problem and cause domain. Correlation between age, duration of treatment, number of comorbidities and number of drugs and the DRP was analysed by Spearman Rho or by Pearson analysis. The relationship between gender, guaranteed care and the DRP was analysed by using Eta analysis.Results: This study revealed that patients with 60-69 years were 24 patients (45.28%), men were 30 patients (57%), 1 comorbidity was 26 patients (49.06%), duration of 5 days was 14 patients (26.42%), BPJS patients were 23 patients (35.94%), using 6 types of drug was 11 patients (20.75%). Age, sex and care guarantee did not correlate with the DRP (p-values > 0.05). Duration of treatment, number of comorbidities and number of drugs correlated with the DRP (p-value <0.05) with consecutive correlation strength: weak (R = 0.32), moderate (R = 0.45), strong (R = 0.56). Conclusion: Duration of treatment, number of comorbidities and number of drugs correlated with increasing incidences of the DRP in geriatric ischemic stroke patients.

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Section: Discussionmentioning

confidence: 99%

“…17,[23][24][25] The longer a patient was treated, the more drugs were prescribed, and the risks of DRP would increase. 17,24 Therefore, it is necessary to optimize roles of clinical pharmacists to prevent incidences of DRP.…”

Section: Discussionmentioning

confidence: 99%

Correlation between geriatric ischemic stroke patient characeteristic and drug related problems

Nugraha

Setiadi

Wibowo

2020

JKKI

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“…Confusion over multiple medications or complex medication regimens and poor counseling by health care professionals can lead to DRPs [4]. Generally, female sex, polypharmacy, renal impairment, co-morbid medical conditions, concomitant medications, nonconformity to standard established guidelines, lack of proper laboratory and therapeutic drug monitoring, pharmacogenetic variations, medication errors, patient-related factors, age over 65 y and use of narrow therapeutic index drugs were identified as risk factors for DRPs [5]. Even though, physicians and nurses, who provide support for better quality outcomes of patients there is a lack of different health care professionals on this issue whether pharmacist manages drug therapy as equivalent to physicians [6].…”

Section: Introductionmentioning

confidence: 99%

The IMPACT OF CLINICAL PHARMACY SERVICES IN GENERAL SURGERY

Battula

Tejaswini²,

Shankar³

et al. 2020

Int J Pharm Pharm Sci

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Objective: The objectives of this study include performing pharmaceutical care-related research and documenting regarding drug-related problems in the surgery department. Further, these types of studies may bring consciousness to both physicians and patients regarding drug use in surgery. Methods: A Prospective interventional study was conducted in a general surgery hospital. The prescriptions were analyzed for the use of inappropriateness of drugs using the classification for drug-related problems. Results: Out of 100 cases, 62 patients were observed with drug-related problems. The number of antibiotics prescribed was 0, 1, 2, 3, 4, 5, 6 in 8, 11, 12, 32, 18, 18, 1 cases respectively. A significant increase in the outcome of antibiotic rationality and cases adhered to guidelines was seen in November compared to October and somewhat decreased in December due to some limitations. The overall study states that prescribing has a more important cause of Drug-related problems compared to dispensing and the use of the drug. Conclusion: Drug-related problems have to be acknowledged as a very important contributing treatment factor for the best health care outcome. Our study shows the importance of clinical pharmacists in every hospital for identifying and resolving drug-related problems and medication errors.

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“…Â³äíîøåííÿ ðèçèêó çàñòîñóâàííÿ ËÇ (ðîçðàõîâóºòüñÿ ÿê ê³ëüê³ñòü ÏÏËÇ, ïîä³ëåíà íà ê³ëüê³ñòü ðàç³â çàñòîñóâàííÿ ËÇ) ïðè âèêîðèñòàíí³ ËÇ ³ç ÂÒ² òà ËÇ ³ç ØÒ² áóëî, â³äïîâ³äíî, 0,50 ïðîòè 0,20 [9]. Çà ðåçóëüòàòàìè ³íøèõ äîñë³äíèê³â, ËÇ ³ç ÂÒ² òàêîae àñîö³þþòüñÿ ³ç á³ëüøèì ðèçèêîì ðîçâèòêó ÍÏÐ, í³ae ËÇ ³ç ØÒ² -0,22 ïðîòè 0,08 [19]. Íàé÷àñò³øå ÍÏÐ âèíèêàëè ïðè âaeèâàíí³ êàðáàìàçåï³íó, ôåí³-òî¿íó, ôóðîñåì³äó, äèãîêñèíó [10].…”

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“…Íàé÷àñò³øå ÍÏÐ âèíèêàëè ïðè âaeèâàíí³ êàðáàìàçåï³íó, ôåí³-òî¿íó, ôóðîñåì³äó, äèãîêñèíó [10]. Ñåðåä ËÇ ³ç ØÒ² ÷àñò³øå ÍÏÐ âèêëèêàëè àíòèïñèõîòè÷í³ (êâåò³àï³í, àì³ñóëüï³ðèä) ³ íåñòåðî¿äí³ ïðîòèçàïàëüí³ (àöåòèë-ñàë³öèëîâà êèñëîòà) ËÇ [19].…”

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RISK MANAGEMENT OF USE DRUGS WITH NARROW THERAPEUTIC INDEX IN CLINICAL PRACTICE. Review

Кhaitovych

2019

Med. Sci. of Ukr.

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Relevance. Today, the pharmacotherapy of many diseases is significantly expanded. However, the amount of pathological conditions associated with the use of drugs has increased. Drug related problems in some cases can be fatal and increase health care costs. It is necessary to be able to anticipate in advance the possibility of developing such conditions, to prevent them. Therefore, the analysis of the causes and mechanisms of development of these conditions is relevant. Objective. To find out the most common causes of drug related problems and consider the mechanisms of such states. Methods. Analysis of scientific publications in PubMed by keywords for the period 2001-2018. Results. The therapeutic index is the ratio of the dose that causes toxic effects in 50% of patients to the dose that causes the expected therapeutic effect in 50% of patients. The therapeutic index ≤ 3 is an indicator that defines drugs with narrow (small) therapeutic index. These drugs include insulin, digoxin, warfarin, levothyroxine, aminoglycoside antibiotics, carbamazepine, lithium, phenytoin, etc. The risks associated with these drugs are: the use of generic drugs with insufficient bioequivalence, pharmacokinetic interaction and polymorphism of genes of drug metabolism. The main mechanisms of their pharmacokinetic interaction at the stages of absorption (alteration of digestive tract motility, influence on the activity of P-glycoprotein), distribution (competition for blood plasma proteins and tissue proteins), and biotransformation (inhibition or induction of metabolism). The role of polymorphism of genes encoding the activity of isoenzymes cytochrome P450 2C9 and 1A2 and glycoprotein P in the development of adverse drug reactions of drugs with a narrow therapeutic index is presented. Conclusion. Risk management of using drugs with a narrow therapeutic index should include therapeutic drug monitoring of especially generic drugs, assessment of the risks of pharmacokinetic interaction, widespread introduction pharmacogenetic tests for determine the polymorphism of the genes of metabolism enzymes and drug transporters in the clinical practice.

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Comparison of Drug Related Problems Associated with Use of Narrow Therapeutic Index Drugs and Other Drugs in Hospitalized Patients

Cited by 6 publications

References 12 publications

Correlation between geriatric ischemic stroke patient characeteristic and drug related problems

Correlation between geriatric ischemic stroke patient characeteristic and drug related problems

The IMPACT OF CLINICAL PHARMACY SERVICES IN GENERAL SURGERY

RISK MANAGEMENT OF USE DRUGS WITH NARROW THERAPEUTIC INDEX IN CLINICAL PRACTICE. Review

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